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Paul Lehmann, HIV/AIDS Section, Population Health Division, Department of Health and Aged Care
The 26th Special Session of the General Assembly of the United Nations, held in New York from 25 to 27 June 2001, represents the high water mark of global political commitment to the fight against HIV/AIDS. It was also the first time in its 54-year history that the General Assembly of the United Nations had convened to discuss HIV/AIDS as a public health issue. More than 20 years since the onslaught of the HIV/AIDS pandemic and after 60 million HIV infections, the world community now has a plan of action for combatting the pandemic.
In calling for the Special Session, the United Nations' objective was to secure a global response to HIV/AIDS through the adoption of a Declaration of Commitment. This Declaration of Commitment would then be used to identify priorities for national, regional and international action and as a yardstick for the Joint United Nations Program on HIV/AIDS (UNAIDS) policy and programs. Importantly, the occasion also served as an opportunity to endorse the Secretary-General's proposed Global Fund for HIV/AIDS and Health.
Australia's delegation to the Special Session was lead by the Minister for Health Michael Wooldridge, and included: the Australian Ambassador to the United Nations, Ms Penny Wensley; the Commonwealth Chief Medical Officer, Professor Richard Smallwood; Chair of the Australian National Council on AIDS, Hepatitis C and Related Diseases (ANCAHRD); Mr Chris Puplick; President of the Australian Federation of AIDS Organisations (AFAO), Mr Bill Whittaker; and representatives from the Population Health Division, Department of Health and Aged Care and the Australian Agency for International Development (AusAID).
Australia played a crucial role in turning the idea of an agreed statement of commitment on HIV/AIDS into a reality. In the months preceding the Special Session in June, Australia's Ambassador to the United Nations, Penny Wensley, co-chaired alongside Ambassador Ka of Senegal, a series of formal and informal meetings convened to draft the Declaration of Commitment. Technical assistance for the process was ably provided by Dr Peter Piot, Executive Director of UNAIDS, and his colleagues.
In the view of many seasoned United Nations (UN) observers, the process of agreement on the wording of text in the Declaration proved to be a particularly arduous and complex one. HIV/AIDS has manifested itself differently in almost every country and region of the world and therefore defies a simple global response. Real national differences often meant that countries came to discuss the issue of HIV/AIDS from vastly different perspectives.
Australia has confronted the sensitive issues connected to HIV/AIDS transmission in the context of a public health approach to the virus. For many other countries, particularly those with strict and widely observed moral codes, open discussion of HIV transmission risk factors, such as those associated with male to male sex, injecting drug use and commercial sex work, was never going to be easy.
Negotiations were further complicated by differences of opinion on issues such as access to HIV/AIDS treatments, and the inevitable nexus between the global response to HIV/AIDS and other global issues such as poverty, under-development, conflict and respect for human rights. Top of page
Highlighting the difficulties in reaching agreement on the wording of text was the fact that final agreement was not reached until after the commencement of the Special Session itself, despite a series of preliminary meetings earlier in the year and round-the-clock efforts over the weekend preceding the Session.
As negotiations drew to a close it became clear, however, that responding to HIV/AIDS at the global level provided many more arguments to unite countries than to divide them. The rousing support for the Declaration of Commitment, which was accepted by the General Assembly by acclamation, served to confirm this fact.
In reaching agreement on the Declaration of Commitment, delegations agreed to the inclusion of a number of important provisions. These include: genuine international agreement and commitment to specific targets for prevention; strong language on human rights and the rights of women to protect themselves from HIV infection; and a sound balance between discussion of education/prevention and treatment/ care. These advances are reinforced at the commencement of each chapter and are part of the process for follow up and evaluation.
As might be expected with a document agreed to by compromise among 189 nations, the Declaration of Commitment from the Special Session has not been without its critics. While the document breaks new ground in a number of areas, it has been criticised for its lack of specificity in others, particularly in relation to the listing of vulnerable groups. Ultimately, however, to focus on these shortcomings would serve to underrate the significant advances contained in the document.
In his statement to the Special Session, Minister Wooldridge emphasised the importance of countries not losing sight of the objective of the Declaration because of particular concerns, for instance, over the identification of vulnerable groups in the Declaration. Participating in a Ministerial round table discussion, Minister Wooldridge outlined our approach in responding to the disease which is recognised internationally as one of the most successful in the world and many aspects of it are widely emulated. He also emphasised our role in developing and financing strategies and programs to combat the pandemic in the Asia-Pacific region.
As the President of the General Assembly noted during his closing remarks, the real work has only just begun. This is no less true for Australia as we continue our efforts to sustain our domestic response to the pandemic.
The key points of Minister Wooldridge's statement to the General Assembly Special Session on HIV/AIDS are summarised below.
- Australia remains well placed to continue its contribution to arresting the spread of, and minimising the personal, social and economic impacts of the HIV/AIDS pandemic. Australia has achieved remarkable success in reducing transmission of HIV infection through sustained political consensus on Australia's HIV/AIDS policy and willingness for government to engage and work with affected and vulnerable communities.
- The Australian Government expressed disappointment that vulnerable groups - men who have sex with men, sex workers, injecting drug users, institutional and prison populations and indigenous people - were not explicitly named in the Declaration of Commitment. In Australia, the support and commitment of such groups and their active involvement and partnership has been the basis of Australia's national response to HIV/AIDS. AIDS activism has been directed towards constructive participation in Australia.
- Promoting prevention is an important part of a comprehensive integrated response which includes all aspects of infrastructure development, treatment, care and support.
- Support and encouragement for a robust and inclusive partnership between a wide range of groups has been a defining feature of Australia's response to HIV/AIDS. The full involvement of communities through, amongst others, civil society organisations including people living with HIV/AIDS, is also crucial to an international response.
- Partnership in decision making, policy development and program implementation continues to ensure that activities combatting HIV/AIDS are effective and sustainable.
- All countries must be involved in HIV/AIDS prevention and control efforts, which extend beyond their domestic situation. Australia's focus for assistance will continue to the Asia Pacific region. In July 2000, the Australian Government announced a new A$200 million Global HIV/AIDS Initiative as a major expansion of Australia's assistance for international work on HIV/AIDS. In implementing the Global Initiative, Australia will continue to support and work collaboratively with UNAIDS and other UN agencies at global and regional levels.
- At a regional level, Australia supports efforts to increase political commitment in responding to the pandemic. To assist these efforts, Australia is hosting the 6th International Congress on AIDS in Asia and the Pacific in Melbourne in October 2001. Australia is inviting Ministers from 38 countries across the Asia-Pacific region to a separate but complementary part of the Congress to consider how to address the broad range of problems caused by HIV/ AIDS, particularly its social and economic impacts.
This article was published in Communicable Diseases Intelligence Volume 25, No 3, August 2001.
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